Provider Demographics
NPI:1942933841
Name:MINT THERAPY LLC
Entity Type:Organization
Organization Name:MINT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:YAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTESMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:305-905-9775
Mailing Address - Street 1:935 STERNER RD
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-3005
Mailing Address - Country:US
Mailing Address - Phone:305-905-9775
Mailing Address - Fax:
Practice Address - Street 1:935 STERNER RD
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-3005
Practice Address - Country:US
Practice Address - Phone:305-905-9775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty